Demographics and epidemiology of sudden deaths in young competitive athletes: from the US national registry.
Maron BJ, Haas TS, Ahluwalia A, Murphy CJ, and Garberich RF. Am J Med. 2016. [Epub Ahead of Print].
Take Home Message: Sudden cardiac death among athletes most often occurred in African-American/Minorities and male athletes. Hypertrophic cardiomyopathy was the most common cause of sudden cardiac death.
Sudden death in sports devastates communities and has garnered much media attention. Understanding the factors associated with sudden deaths could help clinicians develop screening criteria to identify potential cases early. Therefore, Maron and colleagues studied how race and sex influences sudden death among young athletes and their underlying causes. Researchers accessed the US National Registry of Sudden Death in Athletes (1980 to 2011) to gather pertinent information. Deceased athletes were included if they experienced sudden death and engaged in an organized sport. Deaths in club sports, intramural sports, or other causes (automobile accidents, cancer, etc.) were excluded. The researchers calculated incidence rates with public data about the number of athletes participating each year in organized high school and collegiate sports. A total of 2,406 athlete deaths were identified, 214 of which had no recorded cause of death. Of the remaining 2,192 athlete deaths, 842 (38%) deaths were confirmed to have genetic or congenital cardiovascular disease. Males athletes were 89% of all recorded athlete deaths. Male athletes were 8 times more likely to develop sudden death than female athletes. African-American/Minorities were 3.2 times more likely to suffer sudden death than whites. The single most common cause of sudden cardiac death was hypertrophic cardiomyopathy (302, 36%), which was more common among African-American/Minority males (53% of all cases) and white males (44%).
Overall, the data supports prior evidence that African-American/Minority males were most likely to experience sudden cardiac death. This, coupled with the finding that the most common cause of death was hypertrophic cardiomyopathy, suggests that screening methods should focus on these factors. The sports medicine community has hotly debated whether athletes should be screened for risk factors of sudden cardiac death. There’s often concerns about the costs of screening, psychosocial issues related to false positive exams, and our moral obligation to deploy available screening methods to save lives. The researchers suggested that these results highlight the potential value of preparticipation screening in minority communities. While screening all African-American/Minority communities may not be practical, the data presented should signal that more effective and efficient screening methods should be developed. Until such time that a more effective and efficient screening protocol is identified clinicians can still use the data presented to influence clinical practice by being aware of the common signs and symptoms of hypertrophic cardiomyopathy and sudden death (see below). This will allow clinicians to recognize and intervene as quickly as possible, hopefully preventing sudden cardiac death. Furthermore, there is a need for sports medicine clinicians to educate high-risk athletes about their risk so that the athlete and their family can make an informed decision about whether to privately seek screening or participate in sports.
Questions for Discussion: Are you familiar with the signs and symptoms of hypertrophic cardiomyopathy? What types of screening methods do you employ for pre-participation physical examination, if any?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Screening for Sudden Cardiac Death Before Participation in High School and Collegiate Sports: American College of Preventive Medicine Position Statement on Preventive Practice